﻿<div class="row-fluid" id="ua_dialog">
    <form>
        <div class="input-group">
            <span class="input-group-addon">Group</span>
            <input type="hidden" name="id" value="0">
            <input type="hidden" name="groupId" value="0">
            <input type="text" class="form-control required" unsub disabled="disabled" name="group">
        </div>
        <div class="input-group">
            <span class="input-group-addon">Name</span>
            <input type="text" class="form-control required" name="name">
        </div>
        <div class="input-group">
            <span class="input-group-addon">Value</span>
            <input type="text" class="form-control required" name="value">
        </div>
        <div class="input-group">
            <span class="input-group-addon">Count</span>
            <input type="number" class="form-control" name="count">
        </div>
    </form>
</div>